The treatment of distal intra articular femur fractures has been a controversial topic and it has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. For intraarticular femur fractures, periarticular locking plates have been rapidly adopted as an alternative to intramedullary nails, blade plates, and nonlocking condylar screws. However, there is a paucity of data to assess the results when these implants are used in the presence of intra articular involvement and comminution. The aim of this study is to assess the functional and radiological outcomes following fixation of intra articular distal femur fractures with locking compression plate (LCP).
Material and methods: The study period, dated from June 2013 to Dec 2015, included a total of 27 cases of distal femur fracture ( AO/OTA classification type C2 and C3) treated with locking compression plate .The patients’ age ranged from 20 to 77 years and all patients were followed up according to post-operative follow up protocol. The minimum follow up period was 1 year and patients were assessed for functional outcome and radiological signs of fracture healing every month in the outpatient department.
Results: Of the 27 patients treated with distal LCP, 24 Patients (90%) showed radiological union within 20 weeks. 3 patients had delayed union and implant failure. Average time for union was 16.1 weeks. (excluding the cases of implant failure). Average flexion in this study was 113 degree with more than 20 patients having knee range of motion more than 90 degrees. Out of these 20 patients, 10 had a range more than 110 degrees. The functional outcome was measured using Neer’s scoring system, with 59% of the study group having excellent results The complications encountered during the study period involved one superficial skin infection treated by debridement, shortening of 0.5 – 2 cms in three patients which was associated with the extensive communition at the fracture site. There were two patients who at the end of year of follow up showed varus angulation of 7 degrees. 3 patients had an implant failure treated with bone grafting and re application of LCP. 1 patient developed fat embolism.
The results showed a better functional and radiological outcomes when compared to other published studies done on these intra articular fractures using other implant options namely, distal femoral nail, dynamic condylar screw and less invasive stabilisation system (LISS)
Conclusions: The locking compression plates with option of locked screws has provided the means to increase the rigidity of fixation in intraarticular distal femoral fractures. However this is a technically demanding procedure considering the severity of these injuries. We conclude that this method of fixation is especially suited for fractures where achieving congruency of the articular surface would be difficult with less invasive modalities like retrograde nailing and LISS.